Sex-related midterm outcomes after fenestrated and branched endovascular repair for complex aortic aneurysms.

Abstract

To compare the midterm outcomes after fenestrated and branched endovascular repair in male and female patients and to assess factors associated with sex-related outcomes. Data from 423 patients who underwent fenestrated and/or branched endovascular repair between 2016 and 2021 in two aortic centers for degenerative aneurysm or postdissection involving the thoracoabdominal aorta and pararenal aorta were retrospectively collected. The cohort was dichotomized according to sex, and sex-related outcomes after fenestrated and/or branched endovascular repair were assessed. Cases managed for type I to III thoracoabdominal aortic aneurysms were analyzed separately from type IV and pararenal aneurysms. The implanted devices were custom-made devices (COOK Medical) or off-the-shelf t-branch (COOK Medical). Among 423 patients included, 73 (17.3%) were female. Female patients had more extensive disease, with 50.7% treated for type II/III thoracoabdominal aneurysms compared with 23.1% in male patients; consequently, female patients were more frequently treated with branched grafts. The estimated freedom from aorta-related mortality at 12 and 36 months was 99.1% and 93.4% in females and 98.6% and 95.7% in males, respectively (log rank P = .401). In multivariate analysis, female sex remained not associated with aortic-related mortality (hazard ratio [HR]: 0.62, 95% confidence interval [CI]: 0.20-1.91; P = .41). Freedom from aortic-related intervention at 12 and 36 months was 95.7% and 66.3% in females and 92.9% and 72.6% in males, respectively (log rank P = .588). Sex was not significantly associated with target vessel instability after multivariate analysis (HR: 1.28, 95% CI: 0.63-2.57; P = .497). Major adverse events (MAEs) were more frequent among female patients (9.5% vs 2.6%; P = .004) with a higher rate of myocardial infarction, acute renal failure with dialysis, and spinal cord ischemia. In multivariate logistic regression, female sex remained independently associated with a higher risk of MAEs (odds ratio: 0.222, 95% CI: 0.066-0.752; P = .015). In adjusted analysis, no independent association between sex and either device- or procedure-related complications was observed. The extent of aneurysm was not significantly associated with MAEs (HR: 1.137, 95% CI: 0.359-3.598; P = .828). Female sex was independently associated with a higher risk of MAEs, whereas aneurysm-related mortality and rates of aortic reintervention were comparable between males and females at a midterm follow-up after fenestrated and branched endovascular aortic repair.